Evidence included a note Mr. Montain left for his wife and a statement from the doctor who prescribed medication for him four days before he died.

The coroner first read the statement of the nanny who cared for the Montains’ two children and gave an account of what happened on Tuesday, 7 February, 2006.

She said Mr. Montain took his son home from school around 2.30, which was normal. But he also brought a lot of groceries and his work bag, and both of these were unusual. He gave her money to order pizza for supper and asked her to stay until his wife got settled after coming home from work.

The nanny was taking the two children to gymnastics and Mr. Montain changed his son’s clothes, which was also unusual. When the children were in the car with the nanny, Mr. Montain gave his son a snack and asked him to share it with his sister.

When the nanny returned home with the children, no one was there. She noticed Mr. Montain’s cell phone and wallet. When Mrs. Montain came home, she asked where Don was. After going upstairs, Mrs. Montain returned with a paper that said Don was going to drown himself.

The coroner also read a statement from the doctor, who was not Mr. Montain’s regular physician, but saw him on Friday, 3 February.

He complained of flu-like symptoms, nausea, difficulty sleeping and stress for two months but increased in the last week.

The doctor asked what was causing the stress and he said it was work-related, but should improve in a couple of weeks.

The problems were diagnosed as gastroenteritis and insomnia due to stress. The doctor prescribed Maxolon and Stilnoct and suggested that Mr. Montain keep his 6 February appointment with his regular doctor, but Mr. Montain cancelled that appointment.

Mrs. Montain told the court she and her husband had been married 10 years and had come to Cayman six days after their wedding. Both were on work permits.

She said Don had become involved in a business venture and in December he told her it was not doing too well and he might have to pull out and take a loss.

He was losing sleep and getting tingling sensations in his arms. He decided to be medically examined because he couldn’t keep his food down. The stomach problem was not stress-related, but the sleep problem was. After going to the doctor, he felt better but said he felt the drugs weren’t leaving his system. He felt light-headed, nauseous and dizzy.

Mrs. Montain said her husband had spoken to an attorney the previous Wednesday or Thursday and got everything sorted out and indicated to his partner that he was pulling out and they had come to an agreement. After that, Don was more reflective but not acting out of the ordinary.

She described the day of 7 February, 2006, and her conversation with the nanny and the note.

The note said he was going to drown himself because he wasn’t a good provider for the family.

The note had specified an area near the Blow Holes in East End. They found Don’s truck there that night, but did not find him.

The search resumed Wednesday morning and she was on the ironshore when she saw a body in the water. She pointed it out to police and she was taken from the scene before the body was recovered. She later identified her husband at the hospital.

The coroner read the note to the jury and also had copies made for them. Later she referred to a report from Norwitch Document Laboratory to which the note had been sent along with samples of writing known to be by Mr. Montain. The handwriting expert’s opinion was that the note was written by Mr. Montain.

In the note he said he had lost ‘our entire savings’ and could not bear to live with what he had done. He urged her to go to her parents in Canada; he said her family and his would help and be supportive. He left other instructions and concluded ‘I am a coward but I can’t cope any more. You will be better off over time. I love you all so very much.’

Mrs. Montain said her interpretation of what she read in the note was an unusual state of mind for Don. He was an accountant and financial professional; he took numbers seriously and was very precise. He did not exaggerate. He had made reference in the note to losing all their money, but that was fictitious: ‘It was less than half our savings at the time,’ Mrs. Montain said.

She also said they had discussed the money that would be lost and how long it would take to recover. The loss had consequences, but it was not a disaster.

She had spoken to doctors since and had been told that her husband’s symptoms of feeling foggy and dizzy the next day were a strong indication the medication was not working well for him and he should have gone back to the doctor. ‘But we didn’t know that,’ she said.

A chemistry report from the Health Services Authority chief pharmacist said the pharmacy department conducted several searches and was unable to find specific or detailed information linking either Maxolon or Stilnoct directly or indirectly to suicide or suicidal behaviour when taken concurrently.

He said the British National Formulary outlines several Central Nervous System side effects, including drowsiness, restlessness and depression, which have been observed in patients taking Maxolon alone.

Stilnoct, also known as Ambien, is indicated for short-term insomnia. The BNF side effects for this drug include dizziness, memory disturbance and depression.

The ‘Rx List’ Internet Drug Index warns that as with other sedatives/hypnotic drugs Stilnoct should be administered with caution to patients exhibiting signs or symptoms of depression. Suicidal tendencies may be present in such patients and protective measures may be required.

The ‘ePocrates RxPro’ Palm Pilot PDA reference lists suicidal thought as an adverse effect of Stilnoct and states that one possible outcome of interaction between Maxolon and this drug may increase the risk of Central Nervous System depression.

The pharmacist said it could rarely be determined with certainty whether a particular instance of abnormal behaviour was drug induced, spontaneous in origin or a result of an underlying psychiatric or physical disorder.

In her instructions to the jury, the coroner noted there was no history of Mr. Montain having any disability of the mind and he was not under doctor’s care for any psychiatric problem and there had been no talk of suicide.

Other witness statements included those of police officers involved in the investigation and Mr. Montain’s personal assistant. Witnesses giving evidence in person included Mr. Alexander Purdon, who assisted in recovering Mr. Montain’s body from the water, and Government pathologist Dr. John Heidingsfelder, who did not perform the autopsy but answered questions about it.